Healthcare Provider Details

I. General information

NPI: 1912998360
Provider Name (Legal Business Name): HERBERT FRIED KROHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 EVERETT AVE CHC CHELSEA HEALTHCARE CENTER- URGENT CARE
CHELSEA MA
02150-1812
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-884-8302
  • Fax: 617-887-3704
Mailing address:
  • Phone: 617-884-8302
  • Fax: 617-887-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38920
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: